Friday, December 6, 2013
PORTLAND – The prospect of being discharged from St. Joseph's Rehabilitation & Residence is emotionally painful for 86-year-old Rita Michaud.
Albert Michaud, 84, and his wife, Rita Michaud, 86, have been in long-term care after being hit by a car years ago.
Photo courtesy of Audrey Rolfe
Michaud is one of 34 residents at the St. Joseph's assisted-living unit who were notified last week that they will be discharged to make way for a major renovation. They have until Oct. 1 to find other places to live, which may be tough, given the high demand for assisted-living facilities.
"Every day she wakes up thinking she has to move out today," said Michaud's daughter, Audrey Rolfe of Portland. "The anxiety this is creating for her is excruciating."
Rolfe is one of several family members of St. Joseph's residents who contacted the Portland Press Herald to express disappointment and anger about the way the facility is handling the discharge of their loved ones.
State officials and others are overseeing the process to ensure that residents find safe and appropriate accommodations, especially MaineCare recipients, who face the challenge of finding beds when many facilities are underfunded and have long waiting lists.
Family members say they're most upset about the lack of respect being shown for them and the facility's residents, and the lack of clear information about the discharge process and the future of their loved ones.
"For us now to be treated this way by a facility we trusted to take care of her is devastating for all of us," Rolfe said.
They're also upset that the Roman Catholic Diocese of Portland, which owns St. Joseph's, hasn't intervened or responded publicly to concerns about discharges from the facility at 1133 Washington Ave.
Louis Philippe, whose parents will be discharged from St. Joseph's, said he called the chancery in Portland "to let them know just how un-Catholic-like they are treating elderly residents."
The diocese hasn't responded to repeated requests for comment from the Press Herald.
DEMANDS ON SYSTEM GROWING
The situation at St. Joseph's reflects the struggle that long-term care facilities, their residents and their families face across Maine, said Rick Erb, spokesman for the Maine Health Care Association, which represents about 100 nursing homes and 100 assisted-living facilities.
The crisis in long-term care arises, in part, from Maine's median age -- 43.5 years -- which is the highest in the nation. The state's proportion of people 65 and older -- 17 percent -- is second only to Florida's 18.2 percent.
By 2030, more than 25 percent of Mainers will be 65 or older, adding demand on long-term care facilities that already are overburdened.
"I see a whole system that's under stress," Erb said, citing several long-term care facilities that are up for sale, in receivership, eliminating beds or shutting down.
"And it's not as though MaineCare beds were plentiful before St. Joseph's announced its plans," Erb said. He said there's a 92 percent occupancy rate for the 4,232 beds in assisted-living facilities that accept MaineCare, the state's form of Medicaid.
St. Joseph's circumstance also highlights a funding gap that leaves facilities with unreimbursed costs for MaineCare recipients -- 80 percent of assisted-living residents.
MaineCare pays an average of $100 per day -- $3,000 per month -- for eligible residents of assisted-living facilities, Erb said. Those residents also contribute most of their Social Security benefits, about $500 to $1,000 a month.
Meanwhile, assisted-living facilities charge private-pay residents $6,500 or more per month, depending on services and amenities.
St. Joseph's current MaineCare reimbursement rate is $86 per day, Erb said, about $2,580 a month.
Twenty-eight of the 34 residents who are to be discharged are MaineCare recipients, according to the Office of MaineCare Services in the state Department of Health and Human Services.
Rita Michaud, one of only six private-pay residents at St. Joseph's, has been paying $6,444 a month, said her daughter.
"They have to charge private-pay residents more to cover costs," Erb said.
The funding gap also has forced many facilities to put off much-needed renovations for years, Erb said. It's no surprise that St. Joseph's board of directors decided to renovate the assisted-living unit in the 40-year-old facility, he said.
Forty-one percent of MaineCare-dependent assisted-living facilities need to be renovated or replaced, according to the Muskie School of Public Service at the University of Southern Maine.
And yet, Maine lawmakers have raised MaineCare reimbursement rates for assisted living only once in the past eight years -- a 1 percent increase for fiscal 2011-12, Erb said.
Underfunding MaineCare's long-term care services is shortsighted, Erb said, because the "cost shifting" has the unintended consequence of driving up the number of people on MaineCare.
"When assisted-living facilities charge private-pay residents more, it causes people to spend down their assets more quickly, and then they end up on MaineCare too," Erb said.
EVENTUALLY, ASSETS DEPLETED
That's where Rita Michaud is heading, like many seniors.
Michaud has been at St. Joseph's for nearly two years, her daughter said. She moved in after she and her husband, Albert Michaud, 84, were hit by a car several years ago while crossing a street in Old Town, where they lived for decades. The teenage driver was talking on a cellphone.
Their injuries were severe, putting them in rehab for months and accelerating their need for long-term care, Rolfe said.
Albert Michaud's health problems are more severe than his wife's, so he's in the skilled-nursing unit at the Barron Center in Portland, where he's covered by MaineCare.
Rita Michaud has spent about $130,000 of her own money on the only private, recently renovated room at St. Joseph's, Rolfe said. She shares a bathroom with other residents. Most rooms have two beds, and two rooms share a bathroom.
Now, with about $60,000 left, Michaud must try to find a facility that will accept her as a person who has dwindling resources and will soon depend on MaineCare.
"To go to another (assisted-living facility) will be difficult because she doesn't have the upfront cash she once had," Rolfe said. "It really narrows our options tremendously. We don't have the resources to start all over again."
Rolfe said her mother, who has Parkinson's disease, has increasing medical needs and may now qualify for long-term care at the Barron Center, where her parents would be reunited.
CONFLICTING ANSWERS ON FUTURE
Rolfe said she's frustrated, however, that St. Joseph's has disregarded all of the money that her mother has paid and refused to guarantee her a spot in the renovated assisted-living unit.
Rolfe disputes claims by Gail Winchell, St. Joseph's administrator, that she doesn't know how the unit will be reconfigured, how many rooms it will have or how residents will be selected.
Winchell didn't respond to a request for comment Wednesday.
Rolfe said she spoke recently with a representative of Catholic Health East and Trinity Health, the recently merged national nonprofit that operates St. Joseph's for the diocese. The consultant told her that the unit will be renovated into private rooms with private bathrooms, and that current residents will have to reapply if they want to return.
"Why wouldn't my mother's investment be honored?" Rolfe asked rhetorically. "I think they know exactly what they're doing. Once renovations are complete, they have a lot of motivation to fill those beds with private-pay residents."
A regional representative of the Maine Long-Term Care Ombudsman Program visited St. Joseph's on Wednesday to talk with residents and family members, said Brenda Gallant, executive director of the program.
Gallant said her staff will visit St. Joseph's weekly and be available to help residents and family members with the search for new accommodations.
The ombudsman program and the licensing division of the DHHS also will make sure that St. Joseph's follows state laws in discharging residents, Gallant said.
That includes notifying assisted-living residents 15 days before discharge and making sure they have safe and appropriate places to live, she said.
Regardless of statutory requirements, Rolfe said, St. Joseph's is falling short.
"It's not a good plan to begin with," she said, "and it's not being well executed."
Kelley Bouchard can be contacted at 791-6328 or at: